{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JACQUELYN COLEMAN","gend":1,"add":"1769 ACORN ST","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"1983-07-07","age":"","mstatus":"","insh":"2320347*01","cliId":"","pno":"757\/907-5464","cno":"757\/907-5464","email":"","ename":"","eno":"","pphy":"FAYTON, CHARLES E MD","ppno":"757\/962-8605","pcpadd":"1682 CHURCH STREET","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23504,"pcpcounty":"","pcpid":350008,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","I50.9","B35.3","Z23.","Z68.41","M25.569","I45.4","R07.9","I16.0","I50.43","I42.9","Z20.828","D64.9","F41.9","F32.9","Z91.19","Z20.2","I16.1","I43.","Z68.42","I11.0","E66.01","F17.210","Z79.899","Z91.14","V58.69","I42.0","I50.22","F41.8","B34.9","R05.","R68.83","R51.9","M17.0","Z71.6","R06.02","N89.8","I50.31"],"date":["2021-06-09","2021-06-09","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2020-08-25","2020-08-27","2020-08-27","2020-08-28","2020-08-28","2020-12-10","2020-08-28","2020-08-27","2020-08-27","2020-08-27","2020-12-29","2020-08-28","2020-08-25","2021-06-09","2020-08-25","2020-08-25","2020-08-25","2020-08-25","2020-08-28","2020-08-25","2020-09-30","2020-08-25","2021-06-09","2020-12-10","2020-12-10","2020-12-10","2020-12-10","2021-06-09","2021-06-09","2020-08-27","2020-12-10","2020-08-27"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":""}]}]}